Système gastro-intestinal et digestif

Abstrait

Polyvinylidene Fluoride-coated Polypropylene Mesh for Intraperitoneal Onlay Mesh (IPOM) Repair of Ventral and Incisional Herniae

Omer Al-Taan, Sitaramachandra Murthy, Nyasavajjala, Rob CJ Hicks, Khalil H Khalil and Jonathan Guy Finch

Background: Dynamesh is a Polyvinylidene fluoride-coated polypropylene mesh. Its main use is for ventral hernia repairs as an on-lay mesh. The mesh was designed to have similar elasticity to the abdominal wall. It is reported to have good anti-adhesive properties while the large pores ensure rapid integration into the abdominal wall. A small series last year reported a high rate of complications with such a mesh. We have used this mesh with few anecdotal concerns and therefore present a more formal retrospective study of complications in our series.

Method: Theatre logs were reviewed for Hernia cases where Dynamesh was used between April 2007 and January 2011. The notes of patients were reviewed highlighting any recurrence of symptoms, complications or re-operations.

Results: 154 cases were performed during the study period, with 30 using open approach and 124 performed laparoscopically, at our institution, between 9 surgeons. Of these, 7 required laparoscopic division of adhesions. Four of them completed successfully and in 3 cases the mesh had to be removed.

Conclusions: Contrary to the conclusions of the previous study, we find Dynamesh to be effective and safe. Some of the complications relating to our series would be likely to occur with any form of repair. It is true that adhesions do sometimes form to the mesh but these only required re-intervention in 2.5% of cases.